Question
I am working with 2 members of a family who on one level appear to have an auditory processing disorder. However, when their auditory and language skills were evaluated independently they did not test out as having a hearing loss or APD. It should be noted that the parent has held several high level professional positions which he has lost because of frequent misinterpretation of information. His daughter has had trouble in school because of the same issue. The father cannot hold a conversation when background noise is present. I repeat: their auditory and language skills tested out in the normal range. The father's IQ is in the gifted range. These issues have also impacted their family life. I have run both on Fast ForWord. They initially scored below the 10th percentile in 3 of the 6 exercises and are now scoring between 80-100% in all 6 exercises. They notice a significant improvement in interpreting song lyrics but otherwise are not currently observing any other listening improvements in their daily routine. I have put on background classical music when the father is attending to the exercises. He continues to do well. He likes to do 2 exercises with his eyes closed which I have recently asked him not to do. Can you make some suggestions as to how I can help these two?
Answer
I'm a little puzzled by the question/case. You have two clients (a father and daughter) who both report auditory complaints. Reported assessment of auditory and language skills tended to rule out hearing loss and specific auditory processing disorder yet you recommended auditory perceptual training exercises using Fast ForWord. Why? Upon what clinical findings was that therapy recommendation based?
Please don't misunderstand, I think that Fast ForWord is a valuable addition to our rehabilitative arsenal, especially when it's applied to appropriate clients. In this case, however, it appears to have been recommended based NOT upon diagnostic testing but instead upon clients' complaints. That listeners' scores across FF exercises improved over time is a) to be expected in an adaptive training program and b) not evidence that there was a specific perceptual impairment to begin with. If their "auditory and language skills tested out in the normal range" as reported above, why are you pursuing auditory-based therapies, e.g., Fast ForWord with/without background music? One might be led to think that you don't trust your diagnostic test results. If that's the case, then do more auditory-specific diagnostic testing, examining especially your clients' temporal patterning skills.
If, however, your current test results truly rule out a specific auditory processing impairment as a contributing factor to the reported day-to-day listening complaints, then you should refer your clients for evaluation by related professionals. Have either been evaluated for attention deficit disorder, executive function disorder, or nonverbal learning difficulties? The complaints you describe have been noted among clients with these issues.
As we as professionals in human communication sciences/disorders seek the best practices for serving our clients, we MUST keep at least two key points in mind. 1) While it is true that specific auditory processing disorder can adversely affect day-to-day listening (among other things), not all listening complaints are rooted in specific auditory impairment. Remember Jay Hall's observation "one brain, many skills...". And 2) One cannot manage effectively that which has not been diagnosed specifically.
If your clients' issues are not based in auditory deficiency, you must suggest that other avenues be investigated before continuing to recommend additional "auditory therapies".
Dr. Jeanane M. Ferre has been an audiologist for 25 years, specializing in evaluation and treatment of (C)APDs since 1984. She has numerous presentations and writings in this area and is a member of ASHA's Working Group for Auditory Processing Disorders.